Saturday, March 14, 2015

A few years ago I had an arthroscopy in my right knee. It followed acute knee pain that resulted from clumsy attempts to climb a locked gate at the Western Treatment Plant. The pain was intense and "burning" - it lasted several weeks while my GP suggested I rub Voltaren on it which had no effect at all. Finally I went to a "sports doctor" who recommended arthroscopic knee surgery. I was on crutches for a couple of weeks after which the knee went back to normal, the pain gone I think permanently.

I was intrigued therefore to read in this morning's AFR ("Rolfing and Rebates", unfortunately pay-walled) that some insurers (NIB) regard arthroscopies as being ineffective so that, like Rolfing, homeopathy, naturopathy, massage and herbalist treatments (and other evidence-free medical practices) insurance companies should not provide cover for them.

I am not expert on medical issues but I wondered if the claim with respect to arthroscopy is correct true. This article posted online claims they are. It claims the recovery I experienced would probably be achieved by a placebo procedure.

Two issues occur to me:

(1) Should insurance companies provide cover for treatments that consumers demand - if- like homeopathy - there is no clinical evidence they work. One insurer in the AFR answered "yes" to this question since insurance companies should reflect consumer preferences and, presumably, not science. I have problems with this view since providing insurance cover to procedures signals to customers that the procedures are valid. By reducing the effective cost they also increase incentives to use them.

(2) How many more mainstream "respected" treatments (like arthroscopy) are being insured even though there is little clinical evidence they work? I wonder, for example, about the widespread advocacy of Statin drugs for dealing with claimed cholesterol problems: See here - Statins of concern to me as I have taken these drugs for a decade. Or the now discredited, but still practised, advocacy of a carbohydrate-based "food pyramid" that has driven millions into obesity, Type 2 diabetes and heart disease. Ditto the rejection of carbohydrate intake as a treatment for diabetes and obesity.

Monday, March 9, 2015

Ireland has followed Australia in introducing plain packaging of cigarettes. David Prentice and I gave an interview on the Australian experience and its implications for such countries in The World Customs Organisation News, February 2015, Vol 76, pages 62-64. This type of work David and I did on plain packaging won't get prestigious academic awards but in terms of practical policy and promoting the public good I rank it among my best.